Percutaneous brush biopsy and internal drainage of biliary tree through endoprosthesis

1980 ◽  
Vol 134 (4) ◽  
pp. 653-659 ◽  
Author(s):  
G Mendez ◽  
E Russell ◽  
JU Levi ◽  
H Koolpe ◽  
M Cohen
Keyword(s):  
Biliary Tree ◽  
Internal Drainage ◽  
Brush Biopsy

Antegrade transhepatic papillodilatation and dislocation of bile stones in duodenum in management of cholelitiasis

2016 ◽  
Vol 21 (1-2) ◽  
pp. 44-46 ◽  
Author(s):  
Oleg I. Okhotnikov ◽  
M. V Yakovleva ◽  
A. P Kalutskiy
Keyword(s):  
Palliative Care ◽  
Cystic Duct ◽  
Biliary Tree ◽  
Scar Tissue ◽  
Internal Drainage ◽  
Stepwise Manner ◽  
Distal Occlusion ◽  
Peripapillary Area

Endobiliary antegrade stenting by self-expanding stents was performed in 32 patients with unresectable tumors of pancreatobiliary area. Uncoated stents were used in 15 patients with the proximal obstruction of the biliary tree. Uncoated stents prevent the blockade of lobar, segmental and cystic duct. Covered self-expanding stents were used in 17 cases of distal occlusion and obstruction of the peripapillary area. Antegrade stenting drainages of 8Fr were performed in a stepwise manner, consistently performing outside, then outward-internal drainage of the biliary tree, which was transformed into endobiliary stenting. Hybrid endobiliary antegrade stenting, which involves maintaining outward-internal drainage in lumen installed endobiliary stent, was performed in 14 patients. Hybrid antegrade stenting endobiliary allowed to keep endobiliary access to palliative care for all the time, monitor and correct the patency of the stent, by releasing from intraluminal sludge, to carry out a successful reparative stenting “stent to stent” in case of the invasion of tumor or scar tissue in to the lumen of the stent or around of its proximal end.

scholarly journals Infectious Complications after Different Percutaneous External-Internal Biliary Drainage Techniques for Malignant Jaundice

2021 ◽  
Vol 4 (2) ◽  
pp. 51-59
Author(s):  
O. I. Okhotnikov ◽  
M. V. Yakovleva ◽  
S. N. Grigoriev ◽  
V. I. Pakhomov ◽  
N. N. Grigoriev ◽  
...  
Keyword(s):  
Biliary Drainage ◽  
Acute Cholangitis ◽  
Biliary Tree ◽  
Infectious Complications ◽  
Internal Drainage ◽  
Malignant Jaundice ◽  
Liver Abscesses ◽  
Biliary Reflux ◽  
Different Types ◽  
Transpapillary Drainage

Purpose: Analysis of infectious complications incidence in different types of percutaneous externalinternal biliary drainage in patients with obstructive jaundice of tumor genesis.Material and methods: The results of using antegrade external-internal drainage of the biliary tree in transpapillary and suprapapillary variants in 110 patients were analyzed. External-internal biliary drainage was performed in stages, after percutaneous transhepatic cholangiostomy or involuntarily primary with proximal obstruction of the biliary tree with bile duct segregation if it is impossible to form a fixing element of drainage proximal to the obstruction zone.Results: In the first group, transpapillary external-internal drainage was performed in 30 patients with peripapillary tumor obstruction. Of the 26 patients with proximal obstruction, suprapapillary external-internal drainage was performed in 8 patients, transpapillary — in 18 patients. Postmanipulation cholangitis in the first group occurred in 16 cases (28.6 %), liver abscesses developed 4 cases (7.1 %). In the second group, among 30 patients with transpapillary drainage on the background of peripapillary tumor obstruction, signs of acute cholangitis developed in 4 cases. Cholangitis was stopped by timely transfer of external-internal drainage to external. Among 24 patients with proximal obstruction of the biliary tree, suprapapillary external-internal drainage without complications was performed in 18 cases, transpapillary in 6 patients with the proximal block without disconnecting of the biliary tree. Acute cholangitis developed in 2 cases. Patients of the second group had no liver cholangigenic abscesses. There were no cases of hospital mortality in both groups.Conclusion: Factors in the development of postmanipulation cholangitis and liver abscesses during external-internal drainage of the biliary tree against the background of its tumor obstruction are the transpapillary position of endobiliary drainage with duodeno-biliary reflux in persistent biliary hypertension. In the case of suprapapillary location of the working end of external-internal drainage during antegrade drainage of the proximal tumor obstruction of the biliary tree with dissociation, the risk of postmanipulation cholangitis in non-drained liver segments is minimal. In the event of post-manipulation cholangitis in the case of transpapillary drainage of the biliary tree, a temporary transformation of external-internal drainage into external cholangiostomy is necessary.

scholarly journals SOME FEATURES OF CHOLESTASIS IN CANCER PATIENTS DURING THE REDUCTION OF LIVER FUNCTIONAL RESERVES

2018 ◽  
Vol 23 (1) ◽  
pp. 14-19
Author(s):  
Oleg I. Okhotnikov ◽  
M. V Yakovleva ◽  
S. N. Grigoriev ◽  
V. I. Pakhomov
Keyword(s):  
Acute Cholangitis ◽  
Biliary Tree ◽  
Papilla Of Vater ◽  
Internal Drainage ◽  
Invasive Treatment ◽  
Endoscopic Papillotomy ◽  
Distal Tumor ◽  
Functional Reserves ◽  
Transpapillary Drainage ◽  
Made In

Purpose. To determine the indications for the supra - and transpapillary externally-internal drainaging of the biliary tree in case of jaundice syndrome. Material and methods. The results of minimally invasive treatment of 246 patients with external-internal drainage of the biliary tree were analyzed. Among patients with proximal tumor block the external-internal drainage is made in 92 cases, in 42 (45,7%) out of them in suprapapillary embodiment and in 50 (54,3%) - via transpapillary approach. In 154 cases with distal tumor (obstruction peripapillary cancer) transpapillary drainage was performed. Results. The technical success of the external-internal drainaging was achieved in 242 patients (98,4%). It was failed to pass the duodenum in 4 patients with the cancer of common bile duct (3) and cancer of papilla of Vater (1). There was no complications related to the technique of external-internal drainage. In 18 patients (8,8%) out of 204 with transpapillary location of the drainage, we were forced to temporarily return to full outer bile outflow because of acute cholangitis. The syndrome of an acute blockade of the papilla of Vater arising after transpapillary external-internal drainaging required endoscopic papillosphincterotomy in 42 (84%) out of 50 patients with proximal tumor block bile outflow and in 7 (4.5%) out of 154 patients with peripapillary cancer. Conclusion. Suprapapillary and transpapillary embodiment of the drainage are equivalent in terms of the efficacy of cholestasis elimination. Syndrome of an acute blockade of papilla of Vater is the most often complication of the transpapillary external-internal drainage requiring the carrying out of endoscopic papillotomy «on drainage». This syndrome arises very frequently in a case of transpapillary external-internal drainage due to the proximal tumor obstruction of the biliary tree. The risk of acute cholangitis due to regurgitation after manipulation is absent in the suprapapillary location of the external-internal drainage, and with its transpapillary position is realized only with a concomitant violation of the outflow of bile.

Endoscopic Internal Drainage and Low Negative Pressure Endoscopic Vacuum Therapy for anastomotic leaks after oncologic upper gastrointestinal surgery

Endoscopy ◽  
2021 ◽  
Author(s):  
Carlo Jung ◽  
Rachel Hallit ◽  
Annegret Müller-Dornieden ◽  
Melanie Calmels ◽  
Diane Goere ◽  
...  
Keyword(s):  
Negative Pressure ◽  
Treatment Duration ◽  
Treatment Success ◽  
Univariate Analysis ◽  
Gastrointestinal Surgery ◽  
Vacuum Therapy ◽  
Internal Drainage ◽  
Upper Gi ◽  
Endoscopic Internal Drainage ◽  
Endoscopic Vacuum Therapy

Background: Endoscopic internal drainage (EID) with double pigtail stents and low negative pressure endoscopic vacuum therapy (EVT) are treatment options for leakages after upper GI oncologic surgery. We aimed to compare the effectiveness of these techniques. Patients and methods: Between 2016 and 2019, patients treated with EID in five centers in France and with EVT in Göttingen, Germany were included and retrospectively analyzed using univariate analysis. Pigtails were changed every 4 weeks, EVT was repeated every 3-4 days until leak closure. Results: 35 EID and 27 EVT patients were included, with a median leak size of 0.75 cm (0.5-1.5). Overall treatment success was 100% [CI 90; 100] in EID vs. 85.2% [CI 66.3; 95.8] in EVT, p=0.03. The median number of endoscopic procedures was 2 (2; 3) vs. 3 (2; 6.5), p<0.01 and the median treatment duration was 42 (28; 60) vs. 17 days (7.5; 28), p<0.01, for EID vs. EVT, respectively. Conclusion: EID and EVT provide high closure rates for upper GI anastomotic leakages. EVT provides a shorter treatment duration at the cost of a higher number of procedures.

scholarly journals Percutaneous transhepatic biliary puncture simulator: a cord network prototype

2021 ◽  
Vol 6 (1) ◽  
Author(s):  
Rubén Lopez Benítez ◽  
Tomás Reyes del Castillo ◽  
David Benz ◽  
Carsten Fechner ◽  
Lorant Szabo ◽  
...  
Keyword(s):  
Training Session ◽  
Lower Lobe ◽  
Biliary Tree ◽  
Training Model ◽  
Polystyrene Foam ◽  
Wooden Frame ◽  
Biliary Ducts ◽  
Hand Coordination ◽  
Radiology Residents ◽  
Positive Results

Abstract Background The aim of this study was to present a percutaneous transhepatic biliary puncture simulator that can be used without radiation exposure and that reflects the conventional anatomy of the biliary ducts and its vicinity structures. Methods An anatomically based model of the biliary tree was developed using a cord network fixed to a wooden frame. The skin, ribs, intercostal muscles, and right lower lobe pleura were simulated using foam sponge, plastic tubes, a polystyrene foam panel, and an air pad, respectively. For the puncture, we used a 20-G Chiba needle and a wire with distal double arches; these were used to troll a cord, simulating the successful puncture of a bile duct. A camera was also placed above the model to allow the trainees to train eye-hand coordination while viewing the image on a monitor in real time. The simulator was tested with 60 radiology residents to evaluate the confidence and skills transferability of the training model. Results After receiving an introduction of the system and 5 min of training under tutor surveillance, all participants were able to troll a cord of the biliary simulator by themselves in less than 4 min. Only one participant punctured the simulated pleura. The participants’ evaluations showed positive results, with increased user confidence and skills transferability after the training session. Conclusions This proposed simulator can be an effective tool to improve a trainee’s confidence and competence while achieving procedural and non-procedural interventional radiology skills related to the liver. Trial registration Retrospectively registered

scholarly journals AB0545 GASTROINTESTINAL INVOLVEMENT IN SYSTEMIC SCLEROSIS

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1569.2-1569
Author(s):  
A. Argibay ◽  
I. Novo ◽  
M. Ávila ◽  
P. Diéguez González ◽  
M. Estévez Gil ◽  
...  
Keyword(s):  
Systemic Sclerosis ◽  
Gastroesophageal Reflux ◽  
Proton Pump Inhibitors ◽  
Proton Pump ◽  
Biliary Tree ◽  
Motility Disorder ◽  
Anatomical Site ◽  
Digital Ulcers ◽  
Lung Involvement ◽  
Imaging Results

Background:Systemic sclerosis (SSc) is a chronic, connective tissue disease with an autoimmune pattern characterized by inflammation, fibrosis and microcirculation changes leading to internal organs malfunctions. The gastrointestinal tract (GIT) is affected in up to 90% of patients with SSc. Any part of the GIT from the mouth to the anus can be affected. There are few descriptive studies about SSc-related GIT involvement.Objectives:We aimed to characterize the GIT involvement in patients with SSc.Methods:This retrospective study included all patients from SSc cohort of our autoimmune diseases unit in a tertiary referral centre. All patients fulfilled SSc criteria proposed by the American College of Rheumatology. All subjects’ histories were evaluated. Laboratory and imaging results were obtained from the hospital files. Patients with digestive manifestations were compared with patients without GIT involvement. Chi2 and t-student were used, using the statistical package SPSS25.0.Results:83 subjects with SSc were included, 68 (81,9%) of them were women. The mean age at the onset of SSc was 62,1 ± 15,3 years (range 26-89) with a mean follow-up of 9,6 ± 7,4 years. 80,7% of patients had limited SSc, 12% diffuse SSc, 4.8% SSc sine scleroderma and 2,4% early SSc. Considering the immunological profile 12 (14,5%) had Scl70 antibodies, 49 (59%) anticentromere and 21 (25,3%) had ANA antibodies without specificity for anti-Scl70 or anticentromere. 37,3% patients had lung involvement, 20,5% scleroderma and 30,1% digital ulcers. 79,5% of SSc patients were treated with proton pump inhibitors or H2 blockers. 53 (63,9%) patients with SSc had GIT involvement. In 11 patients (20,7%) digestive involvement was diagnosed before SSc (mean 26,2 months). Esophageal involvement occurred in 83%, gastric involvement in 28,3%, intestine involvement in 24,5% and liver and biliary tree involvement in 26,4%. See table 1. No significant differences in age, sex, SSc subtype, autoantibody profile, lung involvement, skin disease, mortality and therapy were observed between patients with or without GIT manifestations. There were no deaths associated with GIT involvement. The most common pharmacologic therapy used was proton pump inhibitors (86,8%), domperidone (20,8%) and antibiotic rotation (17%).EsophagealGastricIntestinalLiver and biliary tree44/53 (83%)15/53 (28,3%)12/53 (24,5%)14/53 (26,4%)Esophageal motility disorder 8 (15,1%)Gastroparesis 6 (11,3%)Small bacterial overgrowth 7 (13,2%)Primary biliary cholangitis 9 (17%)Gastroesophageal reflux 40 (75,5%)Abdominal pain /nausea 10 (18,9%)Colonic inertia 1 (1,9%)Autoimmune hepatitis 3 (5,7%)Dysphagia 11 (20,8%)Subacute gastritis 7 (13,2%)Diarrhea 6 (11,3%)Cholestatic liver enzymes 11 (20,8%)Flatulence / abdominal discomfort 6 (11,3%)Cirrhosis 2 (3,8%)Conclusion:Almost two thirds of our cohort of SSc have symptomatic gastrointestinal disease. GIT manifestations are heterogeneous. Symptoms are non-specific and overlapping for a particular anatomical site. Esophagus is the most commonly affected. More than seventy-five per cent of patients experience symptoms of gastroesophageal reflux. We did not find differences among patients with and without SSc GIT disease. 17% of patients had a Reynold’s syndrome.References:[1]Alastal Y et al. Gastrointestinal manifestations associated with systemic sclerosis: results from the nationwide inpatient simple. Ann Gastroenterol 2017; 30 (5): 1-6.[2]Savarino E et al. Gastrointestinal motility disorder assessment in systemic sclerosis. Rheumatology. 2013; 52(6):1095–100.[3]Steen VD et al. Severe organ involvement in systemic sclerosis with diffuse scleroderma. Arthritis and rheumatism. 2000; 43(11):2437–44.Disclosure of Interests:None declared

scholarly journals Endoscopic Fistulotomy – ‘The Suprapapillary Punch’: A Method of Access to the Bile Duct during ERCP

1994 ◽  
Vol 8 (1) ◽  
pp. 33-35
Author(s):  
Noel B Hershfield
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Endoscopic Retrograde Cholangiopancreatography ◽  
Biliary Tree ◽  
Usual Method ◽  
Endoscopic Retrograde ◽  
The Common ◽  
A Minor ◽  
Endoscopic Fistulotomy

Endoscopic retrograde cholangiopancreatography (ERCP) is established as the method of choice to investigate the biliary tree when obstruction is suspected. On rare occasions, the papilla cannot be entered because of anatomical or pathological abnormalities. This report describes endoscopic fistulotomy or the suprapapillary punch that has been carried out at the Foothills Hospital in Calgary, Alberta, on 30 of 623 patients referred for ERCP for conditions causing obstruction of the common bile duct or suspected obstruction of the common bile duct. The following communication also describes the method of suprapapillary punch or endoscopic fistulotomy. Results have been excellent with only one complication, a minor attack of pancreatitis after the procedure. In summary, the suprapapillary punch or fistulotomy is a safe and useful method for entering the common bile duct when access by the usual method is impossible.

scholarly journals Quantitative multiparametric MRI as a non-invasive stratification tool in children and adolescents with autoimmune liver disease

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Kamil Janowski ◽  
Elizabeth Shumbayawonda ◽  
Lin Cheng ◽  
Caitlin Langford ◽  
Andrea Dennis ◽  
...  
Keyword(s):  
Liver Function ◽  
Spin Echo ◽  
Rank Correlation ◽  
Biliary Tree ◽  
Liver Function Tests ◽  
Multiparametric Mri ◽  
Fast Spin Echo ◽  
Baseline Serum ◽  
Function Tests ◽  
Imaging Markers

AbstractAutoimmune hepatitis (AIH) and autoimmune sclerosing cholangitis (ASC) are two very closely related autoimmune liver diseases with overlapping clinical features and similar management strategies. The purpose of this study was to assess the utility of quantitative imaging markers to distinguish ASC from AIH in paediatrics. 66 participants (N = 52 AIH, N = 14 ASC) aged 14.4 ± 3.3 years scheduled to undergo routine biopsy and baseline serum liver biochemistry testing were invited to undergo MRI (non-contrast abdominal MRI and 3D fast spin-echo MRCP). Multiparametric MRI was used to measure fibro-inflammation with corrected T1 (cT1), while the biliary tree was modelled   using quantitative MRCP (MRCP +). Mann–Whitney U tests were performed to compare liver function tests with imaging markers between patient groups (ASC vs AIH). Receiver operating characteristic curves and stepwise logistic regressions were used to identify the best combination of markers to discriminate between ASC and AIH. Correlations between liver function tests and imaging markers were performed using Spearman’s rank correlation. cT1 was significantly correlated with liver function tests (range 0.33 ≤ R ≤ 56, p < 0.05), as well as with fibrosis, lobular and portal inflammation (range 0.31 ≤ R ≤ 42, p < 0.05). 19 MRCP + metrics correlated significantly with liver function tests (range 0.29 ≤ R ≤ 0.43, p < 0.05). GGT and MRCP + metrics were significantly higher in ASC compared to those with AIH. The best multivariable model for distinguishing ASC from AIH included total number of ducts and the sum of relative severity of both strictures and dilatations AUC: 0.91 (95% CI 0.78–1). Quantitative MRCP metrics are a good discriminator of ASC from AIH.

The case of the disappearing bullet: An extraluminal compression of the biliary tree

Trauma ◽  
2021 ◽  
pp. 146040862110009
Author(s):  
M Mihalik ◽  
N Allopi
Keyword(s):  
Obstructive Jaundice ◽  
South African ◽  
Surgical Intervention ◽  
Biliary Tree ◽  
Common Occurrence ◽  
Abdominal Injuries ◽  
Gun Shot ◽  
Shot Wounds

Penetrating abdominal injuries, especially from gun shot wounds, are a common occurrence in South African hospitals, and a vast majority of these patient receive surgical intervention for suspected intra-abdominal injuries. Not all bullets are found and removed however, and we detail the case of a gentleman who presented to our institution with obstructive jaundice secondary to an extraluminal compression of his biliary tree by a retained migrated bullet, that spontaneously resolved, without any surgical intervention.

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